Provider Demographics
NPI:1871694158
Name:RYBACK, VERONICA REED (LICSW)
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:REED
Last Name:RYBACK
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 HURLBUT ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-1634
Mailing Address - Country:US
Mailing Address - Phone:617-354-6884
Mailing Address - Fax:
Practice Address - Street 1:28 HURLBUT ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-1634
Practice Address - Country:US
Practice Address - Phone:617-354-6884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1026301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical